Balloon valvuloplasty for congenital aortic stenosis: Multi-center safety and efficacy outcome assessment

Alejandro Torres, Julie A. Vincent, Allen Everett, Scott Lim, Susan R. Foerster, Audrey C. Marshall, Robert H. Beekman, Joshua Murphy, Sara M. Trucco, Kimberlee Gauvreau, Ralf Holzer, Lisa Bergersen, Diego Porras

Research output: Contribution to journalArticle

Abstract

Objective To describe contemporary outcomes of balloon aortic valvuloplasty (BAVP) performed in 22 US centers. Background: BAVP constitutes first-line therapy for congenital aortic stenosis (cAS) in many centers. Methods We used prospectively-collected data from two active, multi-institutional, pediatric cardiac catheterization registries. Acute procedural success was defined, for purposes of this review, as a residual peak systolic gradient ≤ 35 mm Hg and no more than mild aortic regurgitation (AR) for patients with isolated cAS. For patients with mixed aortic valve disease, a residual peak systolic gradient ≤ 35 mm Hg without worsening of AR was considered successful outcome. Results In 373 patients with a median age of 8 months (1 day to 40 years of age) peak systolic gradient had a median of 59 [50, 71] mm Hg pre-BAVP and 22 [15, 30] mm Hg post-BAVP (P < 0.001). Procedural success was achieved in 160 patients (71%). The factors independently associated with procedural success were: first time intervention (OR = 2.0 (1.0, 4.0) P = 0.04), not-prostaglandin dependent, (OR=3.5 (1.5, 8.1); P = 0.003), and isolated cAS (absence of AR) (OR = 2.1 (1.1-3.9); P = 0.03). Twenty percent of patients experienced adverse events, half of which were of high severity. There was no procedural mortality. Neonatal status was the only factor associated with increased risk of high severity adverse events (OR 3.7; 95% CI 1.5-9.0). Conclusion In the current era, BAVP results in procedural success (gradient reduction with minimal increase in AR) in 71% of patients treated at US centers where BAVP is considered first-line therapy relative to surgery.

Original languageEnglish (US)
Pages (from-to)808-820
Number of pages13
JournalCatheterization and Cardiovascular Interventions
Volume86
Issue number5
DOIs
StatePublished - Nov 1 2015

Keywords

  • adverse events
  • aortic regurgitation
  • bicuspid aortic valve
  • congenital heart disease

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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    Torres, A., Vincent, J. A., Everett, A., Lim, S., Foerster, S. R., Marshall, A. C., Beekman, R. H., Murphy, J., Trucco, S. M., Gauvreau, K., Holzer, R., Bergersen, L., & Porras, D. (2015). Balloon valvuloplasty for congenital aortic stenosis: Multi-center safety and efficacy outcome assessment. Catheterization and Cardiovascular Interventions, 86(5), 808-820. https://doi.org/10.1002/ccd.25969